Highlights of the statement:
- New American Heart Association PreventsTM The risk calculator estimates the 10-year and 30-year total cardiovascular disease risk for people age 30 and older.
- This calculator estimates your risk of heart attack, stroke, and for the first time heart failure. This equation is gender-neutral and race-neutral, acknowledging that race can include indicators of social determinants of health rather than biological factors.
- It is the first risk calculator to combine cardiovascular, renal, and metabolic health measurements to estimate cardiovascular disease risk.
- This calculator was developed using health information from more than 6 million adults, including people from a variety of racial, ethnic, socioeconomic, and geographic backgrounds.
Editor’s note: Updated on January 11, 2024 to add link to PREVENT calculator.
No entry allowed until 4am 5 a.m. Central Time/5 a.m. Eastern Time, Friday, November 10, 2023
DALLAS, Nov. 10, 2023 — A new calculator combines measures of cardiovascular, renal and metabolic health for the first time to predict cardiovascular disease (CVD) over the next 30 years, according to a new scientific statement from the American Heart Association. ) Published today in the association’s flagship magazine Circulation.
An accompanying methods paper was published simultaneously today. CirculationWe will now share development and testing details, as well as the formula for our new risk calculator. Online tools are under development.
American Heart Association PreventionTM (Pprophesy Rcardiovascular disease risk events) Risk Calculator estimates your risk of heart attack, stroke, and heart failure. This calculator will help you incorporate Cardiovascular Renal Metabolic Syndrome or CKM Syndrome into his CVD prevention. CKM syndrome was first defined in the October 2023 Presidential Recommendation and Scientific Statement. This syndrome refers to the strong association between cardiovascular, renal, and metabolic diseases (type 2 diabetes and obesity).
One in three U.S. adults has three or more risk factors for cardiovascular disease, kidney disease, or metabolic disorders, according to the association’s 2023 statistical update. As the underlying conditions of CKM syndrome worsen, the risk of heart attack, stroke, and/or heart failure increases.
“We needed a new cardiovascular disease risk calculator, especially one that included a measure of CKM syndrome, which is so prevalent in the United States,” said Sadiya S. Khan, M.D., chair of the FAHA statement committee. said the Master. Association. “The new PREVENT risk calculator will allow clinicians to quantify this risk, potentially allowing people to receive preventive care and treatment earlier to reduce their CVD risk. .”
The last CVD risk calculator, the pooled cohort equation, was published in 2013. “However, new treatments are now available for his CKM diseases such as obesity, type 2 diabetes, and kidney disease,” said Kahn, professor of cardiovascular epidemiology at Magerstadt. He is an associate professor of medicine (cardiology) and preventive medicine (epidemiology) at Northwestern University Feinberg School of Medicine in Chicago and a preventive cardiologist at Northwestern Medical School.
“Using the new PREVENT risk calculator to estimate a person’s CVD risk associated with these conditions will facilitate conversations between health care professionals and patients to improve awareness of CKM health status and CVD risk. “This awareness should translate into actions that improve health and reduce risk,” Khan said. “This includes health and lifestyle changes (routine physical activity, healthy eating), and medication if necessary.”
Risk calculators use health, demographic, and/or socio-economic information in an equation to calculate a risk estimate or score. Equations are developed by scientists based on information from national databases, extensive research studies, and electronic medical records.
The PREVENT equation was developed using data from more than 6 million adults in the United States from a variety of racial, ethnic, socioeconomic, and geographic backgrounds. Information from the health records of about half of those people was used to develop the calculator and validated with the other half. Some of the data was collected from research studies, while other data was extracted from electronic medical records of people seeking regular health care outside of research settings. Given this broad population, the calculator is more likely to accurately represent and apply to the general adult population of the United States.
The main differences between the PREVENT calculator and the pooled cohort equation are:
PREVENT is aimed at adults aged 30 years and younger and estimates 10-year and 30-year total cardiovascular disease risk.
The pooled cohort equation was designed to assess the 10-year risk of heart attack and/or stroke in people aged 40 to 79 years. The new calculator can assess CVD risk for people from age 30 to age 79 and can predict risk of heart attack, stroke, and heart failure over the next 10 and 30 years.
“Long-term estimates are important because short-term or 10-year risks in most young adults remain low. We wanted to think more broadly and apply a life-course perspective,” Kahn said. “Providing information about risks 30 years into the future may reveal opportunities for intervention and prevention efforts in younger populations earlier.”
PREVENT can also inform the stage of CKM syndrome in those at high risk to guide further evaluation and treatment recommendations. CKM syndrome ranges from stage 0 (no risk factors and is completely prevention-based) to stage 4, the highest risk, where cardiovascular disease is already present.
The PREVENT risk calculator includes measurements of kidney function.
Kidney function is important for cardiovascular health, and chronic kidney disease increases cardiovascular risk. This calculator includes estimated glomerular filtration rate and uses urinary albumin excretion (which monitors kidney disease) to help further personalize your risk assessment and inform individualized treatment options. Masu.
The PREVENT risk calculator includes a measure of metabolic health.
The PREVENT equation can optionally include hemoglobin A1C, a measure of blood sugar control, to monitor metabolic health. Abnormal blood sugar levels are associated with CVD risk in people with and without type 2 diabetes.
Heart failure risk prediction is also included.
Heart failure is a serious condition in which the heart cannot adequately meet the need for oxygen-rich blood. Heart failure is particularly important in the context of CKM syndrome. For people with obesity, type 2 diabetes, or kidney disease, the risk of heart failure may be higher than the risk of heart attack or stroke.
Race has no bearing on risk calculations.
Although there are clear racial and ethnic disparities in CVD risk factors and CVD incidence based on racial and ethnic social constructs, the statement committee believes that race should be included in PREVENT calculations. concluded that it was not.
The decision is in line with a growing consensus among the scientific and medical communities to remove race from medical algorithms to reduce the likelihood of race-specific treatment decisions.
“The pooled cohort equations were developed using data from only white and black adults, with separate equations for people of each race. For individuals of other racial and ethnic groups. We may not have accurately estimated the risk for many people because we didn’t have a risk model,” Khan said. “Part of the rationale for the race-specific equation was that race was thought to be a proxy or proxy for the lived experience of racism and its potential health effects. However, we were concerned that including race as a proxy could still be harmful.”
The PREVENT calculator shows similar accuracy across different racial and ethnic groups. The equation also includes the option of using a social deprivation index that incorporates measures of social determinants that negatively impact health, such as education, poverty, unemployment, and factors based on the individual’s environment.
“The Prevention Equation is an important first step toward incorporating the health and social factors of CKM into CVD risk prediction,” said Kahn. “Identifying the causal and social factors underlying racial disparities in CVD risk and outcomes requires concerted research efforts. As we strive for more equitable preventive care, We also recognize that racism, not race, operates at multiple levels to increase CVD risk.”
Knowledge gaps and areas for further research.
This statement includes an assessment of knowledge gaps and suggestions for where further research could further improve the prevention equation. These include:
- Incorporates “net benefit” to identify the expected benefit of recommended treatments based on an individual’s level of risk.
- Collecting more data from people of diverse racial and ethnic backgrounds to better represent the growing diversity in the United States The number of Hispanic and Asian people included in the PREVENT dataset is Risk estimates in these populations are less precise because they are smaller than national estimates in the general U.S. population.
- Expand the collection, reporting, and standardization of social determinants of health data, including personal information rather than neighborhood information. Future research should prioritize systematic evaluation of social factors to better understand and address the health impacts of structural racism.
- Extend risk assessment and prevention to key periods of life, such as early in life (childhood and/or adolescence) and the perinatal period, as adverse pregnancy outcomes are associated with increased CVD risk.
- We investigate whether cardiovascular risk prediction can be further optimized by predicting adverse renal outcomes, particularly in the presence and absence of type 2 diabetes.
This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association. The Society’s scientific statements help raise awareness about cardiovascular disease and stroke issues and promote informed medical decisions. A scientific statement outlines what is currently known about a topic and areas where additional research is needed. Scientific statements serve to create guidelines, but do not recommend treatments. The American Heart Association guidelines provide formal clinical practice recommendations.
A list of co-authors/members of the writing group and their disclosures are provided in the manuscript.
The association is primarily funded by individuals. Foundations and corporations (including pharmaceuticals, device manufacturers, and other companies) also make contributions, which help fund specific programs and events for the association. The Society has strict policies in place to ensure that these relationships do not influence scientific content. Revenues from pharmaceutical companies, biotech companies, device manufacturers, health insurance companies, and overall financial information for the association are available here.
Additional resources:
About the American Heart Association
The American Heart Association works tirelessly to help the world live longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with thousands of organizations and the power of millions of volunteers, we fund innovative research, advocate for public health and share lifesaving resources. The Dallas-based organization has served as a leading source of health information for nearly a century. heart.org, Facebook, X Or call 1-800-AHA-USA1.
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